Mental Health: Schizophrenia

Mental illnesses are common in modern-day society. Hence, they continue to be depicted in the media as news articles, clips, documentaries, movies, series, and reality television shows. Schizophrenia is one of the devastating psychiatric illnesses affecting approximately 1% of the world population (Sima, 2023). Scholars state that the illness is associated with adverse physical, mental, and social health outcomes, including poor treatment outcomes, personal suffering, family burden, and disability (Šimunović Filipčić & Filipčić, 2018). Additionally, the illness leads to a reduced life span, with those affected having a 10-30-year shorter life expectancy than a normal individual. Schizophrenia is a serious disorder that can be worsened by various situations, including underlying autoimmune illnesses, unhealthy family relationships, and social difficulties (Özçelik & Yıldırım, 2018). This essay explores the portrayal of schizophrenia in the news (the awakening of April Burrell and Devine Cruz) and entertainment (the movie, "Horse Girl") media.

News Media Portrayal of Schizophrenia

News media portray schizophrenia in different ways; some promote awareness of the illness, others report on new research and findings about the illness, others advocate for the rights of people with schizophrenia, and others report on breakthroughs in treatment. Sima (2023) reports on the awakenings of April Burrell and Devine Cruz, two individuals who had remained in catatonic states for more than a decade with a diagnosis of schizophrenia.

According to the reporter, before her attack, April had been a promising teenager; she was active in school, got excellent grades, and had a happy and engaging social life. However, following a traumatic experience that has been undisclosed, April displayed symptoms of schizophrenia, including a lack of awareness of her family and surroundings, incoherence, and psychosis (Özçelik & Yıldırım, 2018; Sima, 2023). Devine's mental issues started in her middle childhood when she was only nine years old. Her experience started with hearing voices that fought with one another; then they began talking about her as she grew older, finally persuading her to kill herself. Like April, Devine was often unaware of others and her surroundings. She experienced auditory and visual hallucinations and delusions that undermined her daily functioning (Sima, 2023). Doctors diagnosed Devine with schizoaffective disorder and intellectual disability.

Throughout their illnesses, April and Devine received various treatments. April had gone through multiple treatment regimes, including electroconvulsive therapy and medications with mood stabilizers and antipsychotics (Sima, 2023). However, the treatments were ineffective, as she remained in a catatonic state devoid of any awareness. Similarly, Devine underwent various drug treatments with antipsychotic medications and benztropine, clonazepam, lithium, and Ativan (Sima, 2023). Contrary to expectations, the medications proved ineffective and left Devine drooling and shaking, worsening her condition. The two patients received some breakthroughs in the treatment of their condition after experts found out that they had an underlying autoimmune illness, lupus (Sima, 2023). This discovery resulted in new treatment regimens for April, involving the inception of various drugs, including powerful pulses of intravenous steroids, a single dose of cyclophosphamide, and rituximab, mostly used to treat lymphoma. Devine received similar treatments with chemotherapy drugs and corticosteroids (Sima, 2023). The two patients showed significant improvements in various aspects of their lives, including increased awareness of their families and surroundings, return to normal daily functioning, and reduction of schizophrenia symptoms.

Entertainment Media Portrayal of Schizophrenia

Entertainment media like movies, series, documentaries, and reality shows depict schizophrenia in various ways, often in negative ways. Research indicates that most entertainment media depicting schizophrenia often show the one suffering the condition as a psychotic individual bent on wreaking havoc in their lives and the lives of those around them. Such portrayals reinforce negative stereotypes of schizophrenia and perpetuate stigma and discrimination against schizophrenic individuals (Brown, 2021). The movie "Horse Girl," directed by Jeff Baena and starring Alison Brie, focuses on Sarah's life, a craft store salesperson with a love for horses, supernatural detective shows, and making lanyards (Bruney, 2020). Despite the seemingly laid-back life Sarah leads, her life appears to be spiraling out of control as she begins to experience delusions and hallucinations that make her increasingly unsure of reality. According to Horton (2020), Sarah's fear of having a mental illness begins manifesting when she finds scratches on walls, randomly focuses her gaze on innocuous objects, and experiences lapses in her memory and auditory hallucinations in the form of the pitter-patter of bugs. Those are not the only signs Sarah displays. Her roommate's boyfriend encounters Sarah in a catatonic state at one point, where she is blankly staring at the wall and also sleepwalking. As Sarah continues to lose her grip on reality, she experiences obsessions about her grandmother, and her paranoia about alien abductions seems to become a reality in her mind (Bruney, 2020). At the film's end, Sarah is portrayed as an individual without awareness; her grip on reality has been cut as she believes she is her grandmother and is part of a time loop.

Comparison of Media Portrayal of Schizophrenia to DSM-5 Criteria

Schizophrenia is one of the most debilitating mental illnesses affecting the American population. Evidence indicates that around 1% of the global population suffers from schizophrenia (Sima, 2023). The illness adversely affects an individual's functionality, health and wellbeing, and ability to interact with others in their social circles. According to Brown (2021), whenever people hear the term schizophrenia, they think of a person who is amoral, violent, and unclean, indicating that most individuals hold negative stereotypes about the illness, resulting in the stigmatization of those suffering from it. As one of the mental illnesses, the American Psychiatric Association (APA) has included the diagnostic criteria for schizophrenia in its manual, including its symptoms and treatment methods.

Like many other mental illnesses, schizophrenia presents with multiple signs and symptoms. Scholars categorize schizophrenia symptoms into cognitive, positive or psychotic, and negative symptoms (Khan, 2015; National Institutes of Health [NIH], 2021). Cognitive symptoms of schizophrenia include trouble with paying attention or focusing, processing information for decision-making, and memorizing information for later use. NIH (2021) claims that psychotic or positive symptoms refer to those that affect a person's way of thinking, acting, and experiencing the world; they include delusions, movement disorders, hallucinations, and thought disorders. Other than that, schizophrenic individuals manifest negative behaviors like diminished energy and initiative, social withdrawal, anhedonia, and affective flattening (Khan, 2015). The DSM-5 diagnostic manual indicates that for an individual to fit a schizophrenia diagnosis, they must present with two or more of the psychotic symptoms and have a reduced level of functioning in a particular aspect of their lives, like interpersonal relations, work, or self-care, and display continuance signs of the disturbance (APA, 2013). The criteria for diagnosing schizophrenia indicate that when a person presents with the outlined symptoms, the diagnosing attendant should rule out medical or drug use as the source of disturbance and rule out depressive, bipolar, or schizoaffective disorders.

In writing about April and Devine, the reporter demonstrates their struggle with schizophrenia as she outlines their symptoms, which fit the DSM-5 diagnostic criteria for schizophrenia (Sima, 2023). Though the news media's portrayal of signs and symptoms of schizophrenia is accurate, the entertainment media leaves the audience confused as to whether the horse girl indeed has schizophrenia or is experiencing a supernatural ordeal, namely an alien abduction. Nonetheless, the horse girl does present with signs and symptoms that fit the schizophrenia diagnostic criteria, including bizarre delusions that she is an alien abductee and later in her conclusion that she is her grandmother and is in a time loop and erotomanic delusions that she is having intimate relations with her one-time date Darren, whose appearance transforms to the lead actor of her favorite show (Bruney, 2020). Sarah also experiences auditory hallucinations in the form of the pitter-patter of bugs, social detachment, and catatonia as she sometimes blankly stares at the wall or other innocuous objects (Horton, 2020). Both media ideally portray the signs and symptoms that characterize a schizophrenic individual. However, while the article about April and Devine offers hope to those trapped in their minds due to the illness, the movie offers no hope for the ailing as it portrays the illness as a downward, unpreventable spiral into madness.

While symptoms are crucial in determining a diagnosis of schizophrenia, the duration шт which the symptoms present is also crucial to determining the severity of the illness. Based on the DSM-5 criteria, the diagnosing attendant should specify whether the illness is acute, in remission, or continuous. The physician should also specify if the illness is accompanied by catatonia and its severity to inform treatment (APA, 2013). Since their first episodes, April and Devine have presented with continuous symptoms of schizophrenia, with April identifying as catatonic as she remained in a state of complete stupor for two decades (Sima, 2023). April also experienced disorganized speech and social withdrawal, all supported by the DSM-5 criteria. Unlike April, Devine presented with auditory and visual hallucinations, delusions of pregnancy, deterioration in self-care, and detachment from her surroundings (Sima, 2023). According to APA (2013), other associated features supporting the diagnosis of schizophrenia include somatic concerns, dysphoric mood, depersonalization, and derealization. The movie, "Horse Girl," clearly shows these symptoms. In the early phases of her condition, Sarah experiences disturbed sleep patterns characterized by sleepwalking, and as she progresses, she becomes anxious and paranoid about her surroundings (Bruney, 2020; Horton, 2020). Both media provide a conclusive portrayal of the signs and symptoms of individuals who have schizophrenia.

Various factors contribute to the development, course, and incidence of schizophrenia in affected individuals. According to the DSM-5 criteria, psychotic symptoms of schizophrenia usually emerge between one's late teens and mid-30s (APA, 2013). The manual insists that the onset of psychotic symptoms before adolescence is rare, as is the case for Devine, whose symptoms began in middle childhood (Sima, 2023). April's symptoms manifest in her late teens, and Sarah's in her early 30s, which fit into the criteria (Horton, 2020). Scholars associate several risk factors with the incidence of schizophrenia. A majority agree that environmental, genetic, and physiological risk factors may result in incidences of schizophrenia (APA, 2013; Šimunović Filipčić & Filipčić, 2018). The report concerning April and Devine does not specify the reason for the onset of schizophrenia. However, the reporter implies that the autoimmune disease affecting the two women might have been a contributing factor to the onset and severity of schizophrenia. In April's case, her onset may have been triggered by a traumatic event that is omitted (Sima, 2023). In the movie "Horse Girl," Sarah's onset of schizophrenia can be linked to genetics as she has a history of schizophrenia in her family, experienced by her grandmother and mother (Bruney, 2020). For all cases presented in both media, those affected become detached from their family and friends, undermining their recovery and quality of life.

Conclusion

Schizophrenia is one of the most debilitating mental illnesses. As evidenced, the disease adversely affects a person's ability to interact with others and carry out their daily responsibilities. The illness also results in disruptions within families, as in the case of April and Devine, and alienation from friends, as is Sarah's case in Horse Girl. From the comparison above, the news and entertainment media realistically portray schizophrenia. The news media reports on a breakthrough in treatment for those with other illnesses contributing to schizophrenia. At the same time, the movie showcases the symptoms of schizophrenia and the constant struggle to hold on to reality for the affected individual. Despite their divergent showcasing of schizophrenia, the chosen media provide a realistic portrayal of the illness as the signs, symptoms, risks, and treatment indicated align with those outlined in the DSM-5 diagnostic manual.